SMASHBROS Jiu-Jitsu Academy, LLC.
NEW STUDENT REGISTRATION FORM
This form must be filled out, or it will be returned to you for completion. If a question(s) does not apply, please print “N/A” in the space provided. Please keep us informed of any changes.
NAME:{name}
ADDRESS:{address}
HOME PHONE: {phone}
EMAIL ADDRESS:
Birth DATE: {dob}
EMERGENCY CONTACT: {contact_name} PHONE: {contact_phone}
Relationship: {contact_relation}
PARENT/GUARDIAN, IF UNDER 18:
PHONE:
PLEASE SIGN THE WAIVER ON THE END OF THIS FORM
LIABILITY RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE
This is a legally binding liability release, waiver, discharge and covenant not to sue (the “Release”), made by me, the undersigned to SMASH BROS Jiu-Jitsu Academy, LLC., (the “Gym”), to the instructors of the Gym (the “Instructors” or “Professors”), and to the members of the Gym (the “Members”).
The undersigned Participant using SMASHBROS Jiu-Jitsu Academy, LLC., equipment’s, or while on the property, voluntarily makes and grants this waiver and assumption of risk in favor of SMASHBROS Jiu-Jitsu Academy, LLC., its owners, Professors, Instructors and respective entities, referred to as Service providers herein, as partial consideration for the opportunity to use the facilities, equipment, materials and/or other assets of the Service providers; and/or to receive assistance, training, guidance, tutelage and/or instruction from the Service providers; and/or engage in the activities, events, sports, festivities, and/or gatherings sponsored by the Service providers. I do hereby waive and release any and all claims whether in contract or of personal injury, bodily injury, property damage, damages, losses, and/or death that may arise from my aforementioned use or receipt, including but not limited to negligence, mistake, or failure to supervise. I understand and recognize that there are certain risks, dangers and perils connected with such use and/or receipt, which I hereby acknowledge have been fully explained to me and which I fully understand, and which I nevertheless accept, assume and undertake after inquiry and investigation of extent, duration, and completeness wholly satisfactory and acceptable to me.
I further agree to use my best judgment in undertaking these activities, use and/or receipt and to faithfully adhere to all safety instructions and recommendations, whether oral or written. I hereby certify that I am a competent adult/parent/legal guardian assuming these risks of my own free will, being under no compulsion or duress. I will abide by the instructors word at all times and will leave the training area when directed to do so.
I,{name}, fully recognize that there are dangers and risks to which I may be exposed by joining the Gym and participating in Jiu-Jitsu, mixed martial arts, submission grappling which involves strenuous physical activity and extensive physical contact with other people and a mat, including but not limited to joint locks, throws, chokes, strikes, ground fighting, and other similar activity.
Further you represent that you/your child are in good physical condition and have no medical reason or impairment that might prevent you from your intended used of the SMASH BROS Jiu-Jitsu Academy, LLC. facility. As such you acknowledge that the Service providers did not give you medical advice before you joined, and cannot give you any after you join, relating to your physical condition and ability to use the facility. If you have any health or medical concerns now or after you join, discuss them with your doctor before using the facility.
I recognize that this Release means I give up, among other things, rights to sue SMASH BROS Jiu-Jitsu Academy, LLC., its agents, the Instructors and the Members for injuries, damages, or losses I may incur while participating in these activities. I also understand that this Release binds my heirs, executors, administrators, and assigns, as well as myself.
I have read the entire Release; I fully understand it and I agree to be legally bound by it.
This waiver and Assumption of Risk is effective from this day forward inclusive and may not be revoked, altered, amended, rescinded or voided without the express prior written consent of the Service providers.
Printed Name of Participant: Date: {sign_date}
Signature of Participant
Signature of Parent/Legal Guardian (required for Participants under 18 years)
